Thromboelastographic profiles of healthy very low birthweight infants serially during their first month

Abstract

ObjectiveWe determined thromboelastographic (TEG) profiles of healthy very low birthweight infants (VLBWIs) of the day of birth and at set intervals during their first month.DesignProspective observational study with blinded clinical and laboratory follow-up.SettingLevel III neonatal intensive care unit (June 2015 to June 2018).PatientsConsecutive qualifying VLBWIs were enrolled at birth and followed up for 30 days.Interventions and main outcomes measuresLaboratory (citrated-native TEG, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, blood count) and clinical variables were retrieved at birth, 3rd–5th, 10th and 30th day of life. Blood samples temporally related to events with a potential hemostatic impact (sepsis, bleeding, platelets/plasma transfusions, ibuprofen/indomethacin administration) were excluded from analysis.ResultsWe enrolled 201 VLBWIs and 72 full-term neonates. Sixty-seven of the healthy VLBWIs completed the 30-day follow-up. 541 TEG traces were analysed.On day 1, the median (minimum–maximum) TEG values were as follows: reaction time (R), 8.2 min (1–21.8); kinetics (K), 2.8 min (0.8–16); α angle, 51° (14.2–80.6); maximum amplitude (MA), 54.9 mm (23.9–76.8). PT and APTT were 15.9 s (11.7–51.2) and 59 s (37.8–97.5), respectively. The above parameters suggest minor hypocoagulability compared with term infants. On day 30, the median (minimum–maximum) R was 5 (1–16.9), K 1 (0.8–4.1), α 74.7 (41.1–86.7) and MA 70.2 (35.8–79.7). PT and APTT were 12.1 (10.4–16.6) and 38.8 (29.6–51.4), respectively. Those parameters are consistent with a relatively hypercoagulable phenotype, compared with term infants.ConclusionsHealthy VLBWIs have a prolonged PT and APTT, but their TEG profiles suggest a relatively balanced hemostatic system, with slight hypocoagulability initially (compared with term neonates), gradually evolving to a somewhat more procoagulant phenotype over the first month.

Is placental blood a reliable source for the evaluation of neonatal hemostasis at birth?

“…Placental blood cannot be considered as a suitable specimen for a reliable assessment of neonatal hemostasis at birth. Based on current knowledge, TEG should be considered a suitable option to evaluate hemostasis at birth on neonatal blood samples, while still allowing a blood sparing policy. Further studies are needed to unveil the feto‐placental coagulation physiology, to identify the main drivers of the placental blood procoagulant imbalance and to evaluate the clinical implications.…”

Thrombin Generation in Preterm Newborns With Intestinal Failure-Associated Liver Disease

“…Obviously, there might be other explanations, such as the relatively small number of patients enrolled in the IFALD group, compared to healthy preterm infants. Furthermore, we cannot exclude that the more severe clinical conditions of IFALD patients at birth, as supported by their higher CRIB score and the higher incidence of intrauterine growth restriction, may have affected results (12,17,18). Moreover, the higher exposure to antimicrobial drugs may have contributed to alter intestinal flora and subsequent vitamin K synthesis in the IFALD group.…”

“…This study is a secondary analysis of a prospective observational study conducted at the Neonatal Intensive Care Unit (NICU) Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (07/2015-06/2018) that aimed at defining the hemostatic profile in very low birth weight infants in the first month of life (11,12). Inclusion and exclusion criteria and demographic data of the original cohort were detailed elsewhere (11,12). The Institutional Review Board approved the study protocol, and the written informed consent was obtained from patients' tutors.…”

Procoagulant imbalance in preterm neonates detected by thrombin generation procedures

“…This is an ancillary study of a larger prospective observational project aimed at defining the thromboelastographic profile in preterm neonates in the first month of life [16]. The study was approved by the local ethic committee and included consecutive very low birth weight (≤1500 g) preterm infants, born at the Fondazione IRCCS Maggiore Hospital NICU from July 2015 to June 2018.…”